Construction Development Board

CONSTRUCTION DEVELOPMENT BOARD

CONTRACTOR REGISTRATION FORM (CTR01)

(For Medium/Large Contactors only)

SECTION I : GENERAL INFORMATION

1Date of application: ______

2Type of application (please check):

New registration
Re-registration
Upgrading of classification
Additional category head(s)

3Current CDB registration number:______

(for re-registration and upgrading only)

4Trade Licence No : ______

5Name of firm: M/s______

6Name of owner, partners and/or others with controlling interest:

Name / Designation / New CID # / Nationality / Sex

7Registeredaddress of applicant/firm:

Address :
Dzongkhag: / Country: / Post Code:

8Telephone No. :______

9Fax No. :______

10E-mail address: ______

11Type of classification headings applied (check appropriate box/boxes):

Category / Large / Medium / Small
W1 / Roads and Bridges
W2 / Traditional Bhutanese Painting/Finishing Works
W3 / Buildings, Irrigation, Drainage, Flood Control, Water Supply and Sewerage
W4 / Power and Telecommunication Works

SECTION II: HUMAN RESOURCES

12Number of Key Personnel (Permanent Key Employees):

For LARGE CLASS:

Permanent Key Employees: / Category
W1 & W3 / W4
1 / Manager / 1 / 1
2 / Graduate Engineer / 1 (Civil) / 1 (Elec)
3 / Diploma Engineer / 2 (Civil) / 1 (Elec)
4 / Accountant / 1 / 1
5 / Site supervisor / 2 (Civil) / 2 (Elec)

For MEDIUM CLASS:

Permanent Key Employees: / Category
W1 & W3 / W4
1 / Manager / 1 / 1
2 / Diploma Engineer / 1(Civil) / n/a
3 / Site supervisor / 1 (Civil) / 1 (Elec)

Note:

Please attached the following documents of each key personnel (in the sample format of Attachment A) to authenticate information on key personnel:

Curriculum Vitae (CV) of all employeeswith his/her signature including submission of academic transcripts
CID copy (Bhutanese) & Work permit copy (Non-Bhutanese)
Appointment order for the employees
Undertaking letter with legal stamp from employees
Relieving order or NOC from previous employer, and other relevant information to demonstrate competence,

SECTION III: EQUIPMENT AND FACILITIES

13Number of Equipment and Facilities owned.

For LARGE CLASS:

Sl. # / Criteria / Category
W1 / W3 / W4
1 / Excavator/Pay loader / 1 / 1 / N/A
2 / Road Roller / 1 / N/A / N/A
3 / Truck / 1 / 1 / 1
4 / Air Compressor / 1 / 1 / 1
5 / Survey equipment (Total Station) / 1* / 1* / 1*
6 / Concrete mixer / N/A / 1 / 1
7 / Vibrator / N/A / 1 / 1
8 / Crane Truck / N/A / N/A / 1
9 / Steel Shuttering set (sft) / N/A / 5000 / N/A
10 / Water Pump /Multi-meter / N/A / N/A / 1
11 / Meggar / N/A / N/A / 1
12 / Max puller / N/A / N/A / 1

For MEDIUM CLASS:

Sl. # / Criteria / Category
W1 / W3 / W4
1 / Truck / 1* / 1* / 1*
2 / Survey equipments (Leveling Machine) / 1* / 1* / N/A
3 / Concrete mixer / 1 / 1 / N/A
4 / Vibrator / 1* / 1* / 1*
5 / Steel Shuttering set (sft) / N/A / 2000 / N/A
6 / Water Pump /Multi-meter / N/A / 1 / 1
7 / Meggar / N/A / N/A / 1

Note:

To fulfill the minimum mandatory requirement of equipment and facilities, a Contractor must:

Show that the registration of equipments declared to CDB are in the name of applicant/company only.
Submit blue book copies supported by Route Permits and insurances for all RSTA registered equipments.
Submit equipments verification reports duly endorsed by a Govt. Engineer (not less than the rank of AE) for those equipment, which are not dealt by RSTA.

DECLARATION

I/We declare and confirm that:-
All information and attachments submitted in this application are true and correct
The information submitted herein concerning the Applicant/Firm’s financial capacity, personnel, plant & equipment etc pertains solely to the Applicant/Firm and that such information does not relate to or arise from any other Applicant/Firm registered or to be registered at the CDB in which I/We have any interest and/or controlling interest by way of either direct or indirect ownership.
I/We are aware that any false information provided herein will result in the rejection of my application and suspension of any registrations granted.
I/We shall not make refund claims of expenditure incurred in processing this application.
I/We hereby declare that issue of CDB Certificate does not in any way constitute an obligation on the part of CDB or any other Government agency to provide contract works.
I/We do hereby declare that I am not a civil servant/corporate employee or an employee of RGOB funded Autonomous Agencies.

______

(Signature with Nu. 10 legal stamp)

Name in full: ______

I/D No.: ______

In the capacity of : ______

Date: ______

Note:

For Re-Validation:

Applicant is required to submit original CDB certificate.

Construction Association of Bhutan

This is to certify that the facts and figures mentioned by the applicant has been duly verified in preliminary screening by the Construction Association of Bhutanand recommended for detailed assessment by Construction Development Board.

______

Authorised Signatory

CAB

ATTACHMENT A

CURRICULUM VITAE

( C V )

Name:
Position in the company: / Place of Birth:
Date of Birth: / Education:
Nationality: / Address:
Languages:
Date / Employer / Position in the firm / Achievements
(All past details only)
From / To

Reference (Tel.no): 1.

2. ______

(Name and Signature)

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